Provider Demographics
NPI:1205821857
Name:KINNEALEY, ANN E (MD)
Entity Type:Individual
Prefix:MRS
First Name:ANN
Middle Name:E
Last Name:KINNEALEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2740 W FOSTER AVE
Mailing Address - Street 2:LL7
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625
Mailing Address - Country:US
Mailing Address - Phone:773-878-8200
Mailing Address - Fax:773-293-4197
Practice Address - Street 1:800 AUSTIN ST
Practice Address - Street 2:STE 557
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60202-3456
Practice Address - Country:US
Practice Address - Phone:847-869-2076
Practice Address - Fax:847-475-3414
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2016-01-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL036050081207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036050081Medicaid
IL036050081Medicaid
ILK03549Medicare PIN